The review by Wolff et al1 on cannabis-related stroke was an interesting read. The authors have discussed the available evidence on cannabis-related stroke in detail and have also looked at the proposed mechanisms of the same. However, a few questions remain unanswered.

It would have been interesting to know what the method of consumption was in the cannabis users who developed stroke. Because cannabis is usually smoked with tobacco in the form of joints, the question that follows is to what extent can the tobacco, present in the joints, be implicated in the causation of stroke in cannabis users? It is well-known that smoking cigarettes is an important risk factor for stroke2 and, therefore, the contribution of tobacco cannot be overlooked. If there is evidence to suggest that ingesting cannabis is also associated with stroke, it should be brought to light as it provides indirect evidence of a link between cannabis and stroke.

Cannabis is generally perceived as a harmless recreational drug. During the past few years, there has been a lot of support for legalizing cannabis, notwithstanding the overwhelming evidence linking cannabis with psychosis and other adverse effects.3 In the United States, Washington and Colorado have already legalized cannabis and other states may follow suit. In such a scenario, all efforts by researchers to ascertain and highlight the adverse effects of cannabis are welcome. However, unless the evidence offered is robust and convincing, the debate between myth and reality will go on. Hence, I agree with the authors on the need for an epidemiological study to confirm the role of cannabis in causing stroke.

Disclosures

None.

Footnotes

Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org).